Chapter 15 − Provides protection to the kidney

The Urinary System − Helps keep the kidney in its correct

location
 Functions of the Urinary System  Regions of the Kidney
● Elimination of waste products ● Renal cortex – outer region
▪ Nitrogenous wastes ● Renal medulla- inside the cortex
▪ Toxins ● Renal pelvis – inner collecting tube
▪ Drugs − Branching extensions of the pelvis form
● Regulate aspects of homeostasis two or three major calyces
▪ Water balance  Kidney Structures
▪ Electrolytes Medullary pyramids – triangular regions of
▪ Acid-base balance in the blood tissue in the medulla
▪ Blood pressure − broad base of each pyramid
▪ Red blood cell production faces toward the cortex, and its
▪ Activation of vitamin D apex, or papilla (“nipple”), points
internally
 Organs of the Urinary system
● Kidneys ● Renal columns
● Ureters − extensions of cortex- like material inward
● Urinary bladder − Each pyramid and its surrounding cortical
● Urethra tissue constitutes one of approximately
eight lobes of a kidney
 Location of the Kidneys
● Calyces – cup-shaped structures that
− Against the dorsal body wall
funnel urine towards the renal pelvis
− At the level of T12 to L3
− collect urine, which drains
− The right kidney is slightly lower than the
continuously from the papillae,
left
and empty it into the renal pelvis
− Attached to ureters, renal blood vessels,
● renal fascia - an outer layer of dense
and nerves at renal hilus
fibrous connective tissue that anchors the
− Atop each kidney is an adrenal gland
kidney and the adrenal gland to
 Functions of the Kidneys
surrounding structures
 process an enormous volume of blood each
● perirenal fat capsule - a fatty mass that
day
surrounds the kidney and cushions it
 approximately 1200 ml of blood that passes
against blows
through the glomeruli each minute, some
● fibrous capsule - a transparent capsule that
650 ml is plasma, and about one fifth of
prevents infections in surrounding regions
this (120–125 ml) is forced into the
from spreading to the kidney
glomerular capsules as filtrate
 consume 20–25% of all oxygen used by the  Blood Flow in the Kidneys
body at rest
 process about 180 L (47 gallons!) of blood-
derived fluid daily
 less than 1% (1.5 L) typically leaves the
body as urine; the rest returns to the
circulation.  Blood Supply in the Kidneys
 Filtrate contains everything found in blood − cleanse the blood and adjust its
plasma except proteins. composition
 Urine contains unneeded substances such − one-quarter of the total blood supply of the
as excess salts and metabolic wastes. body passes through the kidneys each
 Coverings of the Kidneys minute.
● Renal capsule ▪ renal artery
− Surrounds each kidney − arterial supply of each kidney
● Adipose capsule segmental arteries
− Surrounds the kidney − divides into five segmental arteries
PILONES ,RISHELLE MAE M.
 − deliver one-fourth of the total cardiac  an external parietal layer and a visceral
output (about 1200 ml) to the kidneys layer that clings to the glomerular
each minute. capillaries.
▪ interlobar arteries  The inner (visceral) layer of the capsule is
− several branches that travel through made up of highly modified octopus-like
the renal columns to reach the cortex cells called podocytes
▪ arcuate arteries − long branching processes called
− arch over the medullary pyramids foot processes that intertwine
▪ cortical radiate arteries with one another and cling to the
− branch off the arcuate arteries and run glomerulus
outward to supply the cortical tissue − filtration slits, exist between
▪ cortical radiate veins to arcuate veins to their extensions
interlobar veins to the renal vein − form a porous, or “holey,”
− where the Venous blood draining from membrane around the
the kidney flows through veins that glomerulus
trace the pathway of the arterial ▪ parietal layer
supply but in a reverse direction → simple squamous epithelium
− which emerges from the kidney hilum → contributes to the capsule structure but
and empties into the inferior vena plays no part in forming filtrate
cava ▪ visceral layer
▪ Renal plexus → clings to the glomerular capillaries,
− a variable network of autonomic nerve  Renal Tubule
fibers and ganglia  makes up the rest of the nephron
− provides the nerve supply of the kidney  extends from the glomerular capsule
and its ureter  coils and twists before forming a hairpin
 Nephrons loop and then again becomes coiled and
 The structural and functional units of the twisted before entering a collecting duct
kidneys  Regions:
 Each kidney contains over 1 million of these ▪ Proximal convoluted tubule
tiny blood-processing units ▪ Loop of Henle
 carry out the processes that form urine ▪ Distal convoluted tubule
 collecting ducts, each of which collects ▪ Proximal Convoluted Tubule (PCT)
fluid from several nephrons and conveys it − formed by cuboidal epithelial cells with
to the renal pelvis. large mitochondria, and their apical
 Main structures of the nephrons (luminal) surfaces bear dense microvilli
▪ Renal Corpuscle − increases the surface area and capacity for
▪ Renal tubule reabsorbing water and solutes from the
 Renal Corpuscle filtrate and secreting substances into it.
 located in the renal cortex ▪ Nephron Loop
 consists of a tuft of capillaries called a − formerly called the loop of Henle
glomerulus − has descending and ascending limbs
 a cup-shaped hollow structure called the ▪ Distal Convoluted Tubule (DCT)
glomerular capsule or Bowman’s capsule − are cuboidal and confined to the cortex,
− completely surrounds the glomerulus but they are thinner and almost
 Glomerulus entirely lack microvilli
− A specialized capillary bed ▪ Collecting Duct
− Attached to arterioles on both sides − contains two cell types
(maintains high pressure) Principal cells
− Large afferent arteriole
− Narrow efferent arteriole − receives filtrate from many nephrons
 Glomerular Capsule − run through the medullary pyramids, giving
them their striped appearanc

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− As they approach the renal pelvis, they fuse  Vasa Recta
together and deliver urine into the minor  bundles of long straight vessels
calyces via papillae of the pyramids.  extend deep into the medulla paralleling
◘ principal cells the longest nephron loops
− have sparse short microvilli  play an important role in forming
responsible for maintaining the concentrated urine
body’s water and Na+ balance  Juxtaglomerular Complex (JGC)
◘ intercalated cells  a region where the most distal portion of
− cuboidal cells with abundant the ascending limb of the nephron loop lies
− microvilli against the afferent arteriole feeding the
− two varieties of intercalated cells glomerulus (and sometimes the efferent
(types A and B) arteriole)
− each plays a role in maintaining  includes three populations of cells that
the acid-base balance of the help regulate the rate of filtrate formation
blood. and systemic blood pressure
 Types of Nephrons  macula densa
● Cortical nephrons − “dense spot”
− Located entirely in the cortex − a group of tall, closely packed cells in the
− Includes most nephrons ascending limb of the nephron loop that
− 85% of the nephrons in the kidneys. lies adjacent to the granular cells
● Juxtamedullary nephrons − macula densa cells are chemoreceptors
− Found at the boundary of the cortex that monitor the NaCl content of the
and medulla filtrate entering the distal convoluted
− play an important role in the kidneys’ tubule.
ability to produce concentrated urine  Granular cells
− have long nephron loops that deeply − also called juxtaglomerular (JG) cells
invade the medulla − enlarged smooth muscle cells with
 Nephron Capillary Beds prominent secretory granules containing
 renal tubule of every nephron is closely the enzyme renin
associated with two capillary beds: the − act as mechanoreceptors that sense the
glomerulus and the peritubular capillaries blood pressure in the afferent arteriole
 juxtamedullary nephrons are associated  Extraglomerular mesangial cells
with special capillaries called the vasa recta. − lie between the arteriole and tubule cells
 Glomerulus − interconnected by gap junction
 which the capillaries run in Parallel − may pass regulatory signals between
 specialized for filtration macula densa and granular cells.
 both fed and drained by arterioles  Urine Formation Processes
 afferent arteriole ● Glomerular filtration.
− which arises from a cortical radiate artery, ● Tubular reabsorption
is the “feeder vessel ● Tubular secretion
 efferent arteriole  Glomerular Filtration
− Receives the blood that has passed through − Nonselective passive process
the glomerulus. − Water and solutes smaller than proteins
 Peritubular Capillary Bed are forced through capillary walls
 Arise from efferent arteriole of the − Blood cells cannot pass out to the
glomerulus capillaries
 Normal, low pressure capillaries − Filtrate is collected in the glomerular
 Attached to a venule capsule and leaves via the renal tubule
 Cling close to the renal tubule − takes place in the renal corpuscle
 Reabsorb (reclaim) some substances from − produces a cell- and protein-free filtrate
collecting tubes  The Filtration Membrane
 ultimately drain into interlobar veins  lies between the blood and the interior of
leaving the cortex. the glomerular capsule
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 a porous membrane that allows free − product of protein breakdown
passage of water and solutes smaller than when amino acids are used to
plasma proteins produce energy.
 filtration membrane are engulfed by ▪ Uric acid
specialized pericytes called glomerular − released when nucleic acids are
mesangial cells metabolized.
 3 layers: ▪ Creatinine
1. Fenestrated endothelium of the glomerular − associated with creatine
capillaries. metabolism in muscle tissue.
− allow all blood compo nents except blood  Excess water
cells to pass through.  Tubular Secretion
2. Basement membrane.  essentially tubular reabsorption in reverse
− lies between the other two layers  Some materials move from the peritubular
− composed of their fused basal laminae capillaries into the renal tubules
− forms a physical barrier that blocks all but ▪ Hydrogen and potassium ions
the smallest proteins while still permitting ▪ Creatinine
most other solutes to pass  important for getting rid of substances not
− electrically repels many negatively charged already in the filtrate
macromolecular anions such as plasma ▪ certain drugs
proteins, reinforcing the blockade based on ▪ excess potassium
molecular size ▪ an additional means for
3. Foot processes of podocytes of the controlling blood pH
glomerular capsule.  Materials left in the renal tubule move
− slit diaphragms—thin membranes that toward the ureter
extend across the filtration slits  Formation of Urine
− prevent almost all of them from
traveling farther.
 Tubular Reabsorption
 The peritubular capillaries reabsorb several
materials
▪ Some water
▪ Glucose
▪ Amino acids
▪ Ions
 Some reabsorption is passive, most is
active
 Most reabsorption occurs in the proximal
convoluted tubule
 tubule cells
− “transporters
− taking up needed substances from the
filtrate and then passing them out their
posterior aspect into the extracellular  Characteristics of Urine
space  Colored somewhat yellow due to the
− they are absorbed into peritubular capillary pigment urochrome (from the destruction
blood of hemoglobin) and solutes
− tend to remain in the filtrate  Freshly voided urine-clear and pale to deep
− found in high concentrations in urine yellow
excreted from the body.  Dilute urine is a pale, straw color.
 Materials Not Reabsorbed  Sterile
 Nitrogenous waste products  Slightly aromatic
▪ Urea  Normal pH of around 6
− formed by the liver as an end
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 weighs more, or is more dense, than  In Male , prostate gland-lies inferior to the
distilled water. bladder neck, which empties into the
 Specific gravity of 1.001 to 1.035 urethra
 Solutes normally found in urine  In females, anterior to the vagina and
▪ sodium uterus
▪ potassium ions  Trigone – three openings
▪ Urea ▪ Two from the ureters (ureteral orifices)
▪ uric acid ▪ single opening of the urethra (tinternal
▪ creatinine urethral orifice)
▪ ammonia  trigone
▪ bicarbonate ions − smooth triangular region of the bladder
▪ various other ions depending on blood − base outlined by these three openings
composition − important clinically because infections tend
 Substances not normally found in urine to persist in this region
▪ Glucose
▪ blood proteins  Urinary Bladder Wall
▪ red blood cells  Three layers of smooth muscle (detrusor
▪ Hemoglobin muscle its mucosa is a special type of
▪ white blood cells (pus) epithelium-transitional epithelium)
▪ bile  Walls are thick and folded in an empty
 Ureters bladder
 Slender tubes attaching the kidney to the  Bladder can expand significantly without
bladder increasing internal pressure
▪ Continuous with the renal pelvis  Urethra
▪ Enter the posterior aspect of the  Thin-walled tube that carries urine from
bladder the bladder to the outside of the body by
 Runs behind the peritoneum peristalsis
 Peristalsis aids gravity in urine transport  drains urine from the bladder and conveys
 passageways that carry urine from the it out of the body
kidneys to the bladder  Release of urine is controlled by two
 3 layers sphincters
▪ Mucosa ▪ Internal urethral sphincter (involuntary)
− contains a transitional − involuntary sphincter
epithelium that is con tinuous − controlled by the autonomic
with the mucosae of the kidney nervous system
pelvis superiorly and the bladder − keeps the urethra closed when
medially urine is not being passed
▪ muscularis − prevents leaking between
− composed chiefly of two smooth voiding
muscle sheets: ▪ External urethral sphincter (voluntary)
▪ internal longitudinal layer − voluntarily controlled
▪ external circular layer − surrounds the urethra as it
− appears in the lower third of passes through the urogenital
the ureter diaphragm
▪ adventitia − formed of skeletal muscle
− covering the ureter’s external − levator ani muscle of the pelvic
surface is typical fibrous floor also serves as a voluntary
connective tissue constrictor of the urethra
 Urinary Bladder  Urethra Gender Differences
 Smooth, collapsible, muscular sac ● Length
 Temporarily stores urine ▪ Females – 3–4 cm (1 inch)
▪ Males – 20 cm (8 inches)
● Location
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 ▪ Females – along wall of the vagina ● Normal amount of water in the human
▪ Males – through the prostate and penis body
◘ 3 regions: ▪ Young adult females – 50%
◦ prostatic urethra ▪ Young adult males – 60%
→ about 2.5 cm (1 inch) long, ▪ Babies – 75%
runs within the prostate. ▪ Old age – 45%
◦ intermediate part of the urethra − Water is necessary for many body
→ “membranous urethra” functions and levels must be maintained
→ runs through the urogenital  occupies three main locations within the
diaphragm body (fluid compartments)
→ extends ▪ intracellular fluid (ICF)
→ about 2 cm from the − contained within the living cells
prostate to the beginning of ▪ extracellular fluid (ECF)
the penis. − includes all body fluids
◦ spongy urethra − located outside the cells
→ about 15 cm long, passes ● blood plasma
through the penis and opens at ● interstitial (or tissue) fluid
its tip via the external urethral ● Cerebrospinal serous fluid
orifice. ● the humors of the eye, lymph,
● Function and others
▪ Females – only carries urine  Distribution of Body Fluid
− external urethral orifice lies ● Intracellular fluid (inside cells)
anterior to the vaginal ● Extracellular fluid (outside cells)
opening and posterior to ▪ Interstitial fluid
the clitoris ▪ Blood plasma
▪ Males – carries urine and is a  The Link Between Water and Salt
passageway for sperm cells ● Changes in electrolyte balance causes
 Micturition (Voiding/urination) water to move from one compartment to
 the act of emptying the urinary bladder another
 two sphincters, or valves − Alters blood volume and blood pressure
▪ the internal urethral sphincter (more − Can impair the activity of cells
superiorly located)  Water Intake and Output
▪ external urethral sphincter (more inferiorly  Water intake must equal water output
located)  Sources for water intake
− control the low of urine from the − Ingested foods and fluids
bladder − Water produced from metabolic
 For micturition to occur: processes
(1) the detrusor must contract  Sources for water output
(2) the internal urethral sphincter − Vaporization out of the lungs
must open − Lost in perspiration
(3) the external urethral sphincter must open − Leaves the body in the feces
● Both sphincter muscles must open to − Urine production
allow voiding  Dilute urine is produced if water intake is
▪ The internal urethral sphincter is excessive
relaxed after stretching of the  Less urine (concentrated) is produced if
bladder large amounts of water are lost
▪ Activation is from an impulse sent to  Proper concentrations of various
the spinal cord and then back via the electrolytes must be present
pelvic splanchnic nerves
▪ The external urethral sphincter must be
voluntarily relaxed
 Maintaining Water Balance

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 thirst mechanism is the driving force for
water intake
 Osmoreceptors,when there is an increase
in plasma solute content of only 2 to 3
percent excites highly sensitive cells in the
hypothalamus
− activate the hypothalamic thirst center  Maintaining Acid-Base Balance in
 Regulation of Water and Electrolyte Blood
Reabsorption ● Blood pH must remain between 7.35 and
● Regulation is primarily by hormones 7.45 to maintain homeostasis
▪ Antidiuretic hormone (ADH) prevents ▪ Alkalosis – pH above 7.45
excessive water loss in urine ▪ Acidosis – pH below 7.35
▪ Aldosterone regulates sodium ion ▪ physiological acidosis - pH between
content of extracellular fluid 7.35 and 7.0
− Triggered by the rennin- ● Most ions originate as byproducts of
angiotensin mechanism cellular metabolism
− helps to regulate blood ● Most acid-base balance is maintained by
composition and blood volume the kidneys
by acting on the kidney ● Other acid-base controlling systems
− major factor regulating sodium ▪ Blood buffers
ion content of the ECF ▪ Respiration
● Cells in the kidneys and hypothalamus are  Blood Buffers
active monitors ● Molecules react to prevent dramatic
● Sodium ion (Na+) is the electrolyte most changes in hydrogen ion (H+)
responsible for osmotic water flows. concentrations
 Maintaining Water and Electrolyte ▪ Bind to H+ when pH drops
Balance ▪ Release H+ when pH rises
● Three major chemical buffer systems
▪ Bicarbonate buffer system
▪ Phosphate buffer system
▪ Protein buffer system
 The Bicarbonate Buffer System
● Mixture of carbonic acid (H2CO3) and
sodium bicarbonate (NaHCO3)

● Bicarbonate ions (HCO –) react withstrong

acids to change them to weak acids

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● Carbonic acid dissociates in the presence → occurs when the urethral orifice is located
of a strong base to form a weak base and on the ventral surface of the penis
water → Corrective surgery is generally done when
 Respiratory System Controls of Acid- the child is around 12 months old
Base Balance  glomerulonephritis
● Carbon dioxide in the blood is converted to → common sequel to untreated childhood
bicarbonate ion and transported in the → strep infections glomerular filters become
plasma clogged with antigen-antibody complexes
● Increases in hydrogen ion concentration resulting from the strep infection
produces more carbonic acid  urgency
● Excess hydrogen ion can be blown off with → a feeling that it is necessary to void
the release of carbon dioxide from  frequency
the lungs → frequent voiding of small amounts of urine
● Respiratory rate can rise and fall depending  Nocturia
on changing blood pH → the need to get up during the night to
 Renal Mechanisms of Acid-Base urinate
Balance  urethritis
 Excrete bicarbonate ions if needed → an inflammation of the urethra
 Conserve or generate new bicarbonate  renal calculi
ions if needed → Crystals , When urine becomes extremely
 Urine pH varies from 4.5 to 8.0 concentrated, solutes such as uric acid salts
 Developmental Aspects of the form crystals that precipitate in the renal
Urinary System pelvis
● Functional kidneys are developed by the → Surgery has been the treatment of choice,
third month but a noninvasive procedure (lithotripsy)
● Urinary system of a newborn that uses ultrasound waves to shatter the
▪ Bladder is small calculi is becoming more popular
▪ Urine cannot be concentrated  oliguria
● Control of the voluntary urethral sphincter → An abnormally low urinary output between
does not start until age 18months 100 and 400 ml/day
● Urinary infections are the only common  anuria
problems before old age → less than 100 ml/day
 Aging and the Urinary System  hydronephrosis
● There is a progressive decline in urinary → urine that can no longer pass through the
function ureters backs up
● The bladder shrinks with aging → exerts pressure on the kidney tissue
● Urinary retention is common in males → can severely damage the kidney
Homeostatic Imbalances
● Adult polycystic
→ kidney disease is a degenerative condition
that appears to run in families
→ One or both kidneys enlarge
→ size of a football
→ have many blisterlike sacs (cysts)
containing urine
→ progresses rapidly, resulting in death by 2
years of age
→ Renal failure is the eventual outcome, but
kidney transplants improve chances for
survival.
 Hypospadias
→ a condition found in male babies only

PILONES ,RISHELLE MAE M.